Sunday, October 25, 2009

Dan Balz has a recap of the progress of health care reform that seems, to me, to get just about everything wrong. He begins:

The resurrection of the public option is the latest and one of the most surprising turns in the long battle over legislation to overhaul the nation's health-care system. Under assault for months, and declared on life support repeatedly in recent weeks, the provision for a public insurance option is unexpectedly alive as House and Senate leaders prepare to send their bills to the floor.

I'm sure that some people buried the public option, but only if they weren't paying attention or didn't understand the process. First of all, on the House side, all three of the bills to be merged contained a public option, so while the leadership certainly could have stripped it out of the final bill, it would have been a pretty significant surprise if the House bill didn't have a public option.

More basically, the entire narrative from the beginning went like this: the House is more (operationally) liberal than the Senate, and the Senate as a whole is more liberal than the Senate Finance Committee. Therefore, the Senate Finance Committee bill was always expected to be the least favorable to a public option, and everyone expected the merged Senate bill to be more liberal than the Senate finance bill (and the final bill after conference to be more liberal than the Senate bill). So what's happening now is basically what most people thought would happen from the beginning; the biggest change is that the schedule has slipped, but that's hardly a surprise.

Balz, however, has constructed a counter-narrative that explains the supposed near-death and resurrection of the public option, and it seems to rest on things that just didn't happen. For example, Balz would have it that "conservative opposition nearly sank the public option over the summer." I would say that the reality of the summer was very different. There was no concentrated attack on the public option; instead, there was a kitchen-sink approach to attacking health care in reform in general, with the most visible specific strands of the attack focused first on "death panels" and then on Medicare "cuts." There was also a broad attack on socialism and a government takeover, but I don't think that any of that was specific to the public option; indeed, much of it wasn't even specific to health care. Certainly, there was never a sense that Democrats could produce a bipartisan bill if only they dropped the public option, a sense confirmed in the discussions and voting in the Senate Finance mark-up. The real story about Republican opposition (and Ezra Klein talked about this recently, but I'm afraid I lost the link) is that they chose a rejectionist strategy, which meant that they had no influence on the specifics of the bill.

Balz also misunderstands the president's role in the fight. For Balz, the president's equivocation on public option was a signal that he didn't really want it. But Obama's game from the start has been to let Congress haggle over the details. The president failed to strongly support the public option -- but he also failed to strongly support any of the various proposals, including individual mandates, employer mandates, subsidy levels, end of life provisions, or anything else. Whether it was a good strategy or not is a fair question, but it was a clear strategy to allow the president to eventually treat the final bill as a victory.

Next: the Senate Finance committee votes. Balz says that when Baucus "joined several other Democrats in opposing two versions of a public option in the committee's bill, saying he saw no way to get 60 votes in the full Senate. That seemed to spell the end for the public option." First of all, since "two" is not "several," this is just bad reporting; only Conrad, Lincoln, and Baucus opposed the Schumer "weak" public option, with Bill Nelson and Carper voting for Schumer's amendment. The obvious conclusion was that the strongest versions of the public plan were indeed dead in the Senate -- something that appears to still be the case -- but that some sort of compromise was likely in the Senate merged bill. In fact, WaPo's own Ezra Klein reacted to those votes by going out and conductinginterviews on the subject of "public option compromises."

In Balz's version of events, the dead public option sprang back to life as a result of two events:

One was the insurance industry's decision to attack the legislation and issue a report warning of higher premiums. The report triggered a backlash among liberal Democrats, who decided to push even harder for a public option. Then last week, new polls, one from The Washington Post and ABC News and the other from the Henry J. Kaiser Family Foundation, found clear majority support (57 percent) for a public option.

Outside of the timeline being all wrong (since, as I said, public option compromises were alive and well before these two events), I think it's hard to see why either of these would have moved votes. The insurance industry was against the public option all along, and some might recall that the president began portraying insurers as villains during his August push-back against the Town Hall crazies. As for the polls, they only showed that the public option continued to poll well; they did not indicate anything new at all.

I do agree with Balz on where we are now: a public option compromise is likely, but not certain, and the bill as a whole is likely, but things could still fall apart. The rest of it, alas, is just not what actually happened over the last few months.